Brain structural deficits and working memory fMRI dysfunction in young adults who were diagnosed with ADHD in adolescence.

When adolescents with ADHD enter adulthood, some no longer meet disorder diagnostic criteria but it is unknown if biological and cognitive abnorma lities persist. We tested the hypothesis that people diagnosed with ADHD during adolescence present residual brain abnormalities both in brain structure and in working memory brain function. 83 young adults (aged 20-24 years) from the Northern Finland 1986 Birth Cohort were classified as diagnosed with ADHD in adolescence (adolescence ADHD, n = 49) or a control group (n = 34). Only one patient had received medication for ADHD. T1-weighted brain scans were acquired and processed in a voxel-based analysis using permutation-based statistics. A sub-sample of both groups (ADHD, n = 21; controls n = 23) also performed a Sternberg working memory task whilst acquiring fMRI data. Areas of structural difference were used as a region of interest to evaluate the implications that structural abnormalities found in the ADHD group might have on working memory function. There was lower grey matter volume bilaterally in adolescence ADHD participants in the caudate (p < 0.05 FWE corrected across the whole brain) at age 20-24. Working memory was poorer in adolescence ADHD participants, with associated failure to show normal load-dependent caudate activation. Young adults diagnosed with ADHD in adolescence have structural and functional deficits in the caudate associated with abnormal working memory function. These findings are not secondary to stimulant treatment, and emphasise the importance of taking a wider perspective on ADHD outcomes than simply whether or not a particular patient meets diagnostic criteria at any given point in time.This work was supported by an Academy of Finland Award to Dr Veijola; a Sigrid Juselius Foundation grant to Dr Moilanen; a Medical Research Council fellowship to Dr Murray (G0701911); a NARSAD, the Brain and Behavior Research Fund independent investigator award to Dr Miettunen; an Oon Khye Beng Ch'Hia Tsio Studentships in Preventative Medicine awarded by Downing College, Cambridge to Dr Roman-Urrestarazu together with a Becas Chile Doctoral Grant awarded by CONICYT, an Academy of Finland grant and Finnish Medical Foundation grant to Dr Kiviniemi, and an award from the Signe and Ane Gyllenberg Foundation, Finland, to Dr Mäki.. The work was partially conducted with the University of Cambridge Behavioural and Clinical Neuroscience Centre, supported by a joint award from the Medical Research Council (G1000183) and Wellcome Trust (093875/Z/10Z).This is the final version of the article. It first appeared from Springer via http://dx.doi.org/10.1007/s00787-015-0755-

Do inattention and hyperactivity symptoms equal scholastic impairment? evidence from three European cohorts

Background Attention Deficit/Hyperactivity Disorder (ADHD) affects many children, adolescents, and adults and is associated with a number of impairments. Poor academic performance is related to ADHD in clinical samples. However, it is unclear to what extent core ADHD symptoms and scholastic impairment are related in non-referred school-aged children. Methods Data come from three population-based cohorts from Sweden, Denmark, and Finland, which are part of the Nordic Network on ADHD. The combined sample size was 13,087 children who were studied at ages 7–8 or 10–12 years. Teachers rated children on inattention and hyperactivity symptoms and reported children's scholastic performance on basic skills. Results There was a significant association in all cohorts between core ADHD symptoms and scholastic impairment in reading, writing, and mathematics. Particularly, inattention was related to a two to tenfold increase in scholastic impairment. Prevalence of hyperactivity symptoms was similar across the three cohorts, but inattention was lowest among children from the Finnish cohort, after stratification on living conditions. Conclusion These results extend previous reports of scholastic impairment among children with clinically diagnosed ADHD to non-referred population samples from three European countries. Surveillance policies should be implemented in school systems to catch children in need of behavioral or scholastic support early

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Shared Genetic Risk Factors of Intracranial, Abdominal, and Thoracic Aneurysms

Background-Intracranial aneurysms (IAs), abdominal aortic aneurysms (AAAs), and thoracic aortic aneurysms (TAAs) all have a familial predisposition. Given that aneurysm types are known to co-occur, we hypothesized that there may be shared genetic risk factors for IAs, AAAs, and TAAs. Methods and Results-We performed a mega-analysis of 1000 Genomes Project-imputed genome-wide association study (GWAS) data of 4 previously published aneurysm cohorts: 2 IA cohorts (in total 1516 cases, 4305 controls), 1 AAA cohort (818 cases, 3004 controls), and 1 TAA cohort (760 cases, 2212 controls), and observed associations of 4 known IA, AAA, and/or TAA risk loci (9p21, 18q11, 15q21, and 2q33) with consistent effect directions in all 4 cohorts. We calculated polygenic scores based on IA-, AAA-, and TAA-associated SNPs and tested these scores for association to case-control status in the other aneurysm cohorts; this revealed no shared polygenic effects. Similarly, linkage disequilibrium-score regression analyses did not show significant correlations between any pair of aneurysm subtypes. Last, we evaluated the evidence for 14 previously published aneurysm risk single-nucleotide polymorphisms through collaboration in extended aneurysm cohorts, with a total of 6548 cases and 16 843 controls (IA) and 4391 cases and 37 904 controls (AAA), and found nominally significant associations for IA risk locus 18q11 near RBBP8 to AAA (odds ratio [OR]= 1.11; P=4.1 x 10(-5)) and for TAA risk locus 15q21 near FBN1 to AAA (OR=1.07; P=1.1 x 10(-3)). Conclusions-Although there was no evidence for polygenic overlap between IAs, AAAs, and TAAs, we found nominally significant effects of two established risk loci for IAs and TAAs in AAAs. These two loci will require further replication.Peer reviewe

Shared Genetic Risk Factors of Intracranial, Abdominal, and Thoracic Aneurysms

Background: Intracranial aneurysms (IAs), abdominal aortic aneurysms (AAAs), and thoracic aortic aneurysms (TAAs) all have a familial predisposition. Given that aneurysm types are known to co‐occur, we hypothesized that there may be shared genetic risk factors for IAs, AAAs, and TAAs. Methods and Results: We performed a mega‐analysis of 1000 Genomes Project‐imputed genome‐wide association study (GWAS) data of 4 previously published aneurysm cohorts: 2 IA cohorts (in total 1516 cases, 4305 controls), 1 AAA cohort (818 cases, 3004 controls), and 1 TAA cohort (760 cases, 2212 controls), and observed associations of 4 known IA, AAA, and/or TAA risk loci (9p21, 18q11, 15q21, and 2q33) with consistent effect directions in all 4 cohorts. We calculated polygenic scores based on IA‐, AAA‐, and TAA‐associated SNPs and tested these scores for association to case‐control status in the other aneurysm cohorts; this revealed no shared polygenic effects. Similarly, linkage disequilibrium–score regression analyses did not show significant correlations between any pair of aneurysm subtypes. Last, we evaluated the evidence for 14 previously published aneurysm risk single‐nucleotide polymorphisms through collaboration in extended aneurysm cohorts, with a total of 6548 cases and 16 843 controls (IA) and 4391 cases and 37 904 controls (AAA), and found nominally significant associations for IA risk locus 18q11 near RBBP8 to AAA (odds ratio [OR]=1.11; P=4.1×10−5) and for TAA risk locus 15q21 near FBN1 to AAA (OR=1.07; P=1.1×10−3). Conclusions: Although there was no evidence for polygenic overlap between IAs, AAAs, and TAAs, we found nominally significant effects of two established risk loci for IAs and TAAs in AAAs. These two loci will require further replication

School professionals committed to student well-being

Abstract The northern provinces of Finland are mostly not densely populated, with long distances to healthcare services. This creates a challenge for how to reach all children and adolescents with mental health services. In order to assess the effectiveness of school-based mental health promotion interventions, it is essential to understand the views of school professionals on student well-being and mental health promotion activity in schools. This study was carried out in urban area comprehensive schools where psychiatric nurses delivered additional mental health promotion interventions. The data were collected using a questionnaire, and a mixed-methods approach was utilised in the analysis. School professionals perceived that students are more unwell than before; they exhibit a general disregard for their well-being and more mental health problems. The respondents regarded the promotion of students’ mental health as a basic function of schools. Teachers need adequate support with this work

A psychoeducational mental health promotion intervention in a comprehensive schools:recognising problems and reducing stigma

Abstract Objective: Adolescence is a vulnerable age for emerging mental health problems, but also a time at which the foundations for a healthy lifestyle are established. Attitudes towards mental health problems and the ability to recognise them can be affected at this age. The aim of this study was to describe a psychoeducative intervention aimed at increasing knowledge of mental health problems and decreasing the stigma of mental health disorders among eighth-grade students in Finland. Design: Mixed-methods exploration of how a universal psychoeducation delivered in the classroom can affect attitudes towards, and recognition of, mental health disorders and how young people perceive the psychoeducation received. Setting: The study involved 162 eighth-grade students in two comprehensive schools in Finland. Method: The intervention consisted of four lessons on the topics of anxiety, eating disorders, conduct disorder, and depression and substance use. Results: Students in both the intervention and non-intervention groups recognised the symptoms of mental health disorders well before and after the intervention, and the intervention improved boys’ ability to recognise conduct disorder. Following the intervention, students saw mental health disorders as real medical conditions. Students experienced the intervention as beneficial, increasing their knowledge, understanding and open-mindedness with regards to mental health. Conclusions: Mental health promotion interventions have the goal of increasing the ability of individuals to understand mental health issues and engage in self-care of mental health. Providing mental health promotion interventions to young people has the potential to increase knowledge and skills in maintaining a healthy lifestyle in adulthood

Let’s Talk about Children Evaluation (LTCE) study in northern Finland:a multiple group ecological study of children’s health promotion activities with a municipal and time-trend design

Abstract Introduction: Making change towards child and family-based and coordinated services is critical to improve quality, outcomes and value. The Let’s Talk about Children (LTC) approach, which consists of brief psychoeducational discussions with parents of kindergarten-aged and school-aged children, has been launched as a municipality-specific programme in the Council of Oulu Region. The aim of this paper is to present a protocol of an ecological study evaluating the group-specific effects of an intervention about LTC activities in a geographically defined population. The programme is designed to promote children’s socioemotional well-being. Methods and analysis: A quasi-experimental ecological study protocol is implemented to evaluate whether systematic LTC practices improve children’s well-being. A multi-informant setting covers 30 municipalities in northern Finland and involves all the municipal teachers, social and healthcare workers. In each municipality, a Local Management Team is responsible for implementing the LTC programme and collecting the annual data of LTC discussions and network meetings. The outcome data are retrieved from child welfare statistics and hospital registers. The population data, child welfare statistics and referrals to hospitals was retrieved at baseline (2014), and will be retrieved annually. Furthermore, the annual data of LTC discussions and network meetings will be collected of the years 2015–2018. Ethics and dissemination: The study design has been approved by the management of the Oulu University Hospital in accordance with the guidelines given by The Regional Ethics Committee of the Northern Ostrobothnia Hospital District in Oulu, Finland. All data are treated and implemented according to national data security laws. Study findings will be disseminated to provincial and municipal partners, collaborative community groups and the research and development community. The Let’s Talk about Children Evaluation study databases will guide future regional development action and policies

Lasten psykoterapiat

Tiivistelmä Mielenterveyden häiriöiden synnyn ja hoidon kannalta lapsuuden tekee erityiseksi aivojen voimakas muovautuvuus. Muovautuvuuden vuoksi aivot ovat herkemmät kielteisten kokemusten vaikutuksille, mutta toisaalta hoidolla on mahdollista korjata vaurioita ja mahdollistaa myöhempi terve kehitys. Lasten mielenterveyden häiriöiden hoito koostuu monista hoito- ja kuntoutusmenetelmistä, joista psykoterapia on yksi. Tavallisimmat leikki- ja kouluikäisten lasten mielenterveyden häiriöiden hoitoon käytettävät psykoterapian muodot ovat kognitiivinen käyttäytymisterapia, psykodynaaminen psykoterapia ja perhepsykoterapia. Asianmukaisella psykoterapeuttisella hoidolla voidaan usein korjata lapsen mielenterveyden häiriöön liittyneitä haitallisia ajatus- ja käyttäytymismalleja, parantaa lapsen toimintakykyä kotona ja kodin ulkopuolella sekä mahdollistaa myöhempi iänmukainen kehitys. Varhain toteutettu hoito vähentää lasten ja perheiden inhimillistä kärsimystä, ehkäisee syrjäytymistä ja säästää terveydenhuollon voimavaroja.Abstract Child psychotherapy The plasticity of the brain makes childhood an important period for the development and treatment of mental health disorders. Due to this plasticity, adverse childhood experiences have a stronger effect on the developing brain. However, this same plasticity may also enhance the effects of treatment, making later healthy development possible. Psychotherapy is one method for treating mental health disorders in childhood. The most common types of child psychotherapy currently used in Finland are cognitive-behavioral psychotherapy, psychodynamic psychotherapy, and family psychotherapy. With adequate psychotherapeutic treatment, it is often possible to alter a child’s dysfunctional thought and behaviour patterns, help the child function better both within and outside the home, and enable later age-appropriate psychological development. The early treatment of children’s mental health problems reduces the suffering of the child and the family. Furthermore, it reduces the risk of exclusion from society, and thus saves social and health service resources in the long run